Health Calls Season 6, Episode 14 examines how health systems across the United States are collaborating to lower medication costs through the groundbreaking nonprofit manufacturer Civica Rx. Host Brian Reardon and Executive Producer Josh Matejka speak with Dr. Daniel Roth, Executive Vice President and COO of Trinity Health, about how Civica was founded to address persistent generic drug shortages, supply chain disruptions, and affordability issues affecting hospitals nationwide.
Health Calls Season 6, Episode 14 examines how health systems across the United States are collaborating to lower medication costs through the groundbreaking nonprofit manufacturer Civica Rx. Host Brian Reardon and Executive Producer Josh Matejka speak with Dr. Daniel Roth, Executive Vice President and COO of Trinity Health, about how Civica was founded to address persistent generic drug shortages, supply chain disruptions, and affordability issues affecting hospitals nationwide.
Dr. Roth explains how Civica brings together Catholic health systems, nonprofit providers, for‑profit partners, and philanthropic organizations to create a health‑utility model that prioritizes stable supply over profit. He details how Civica now supports more than 1,400 hospitals with affordable generic medications and is expanding its portfolio based on national clinical need. This episode highlights why cross‑sector collaboration is essential for U.S. patients, clinicians, and caregivers—and how collective action can reduce costs, strengthen supply chains, and advance whole‑person care across the country
Brian Reardon (00:05):
Welcome to Health Calls, the podcast of the Catholic Health Association of the United States. I'm your host, Brian Reardon. With me is Josh Matejka. Hello, Josh.
Josh Matejka (00:13):
Hey, Brian. How are you doing?
Brian Reardon (00:14):
I'm doing good. This episode, we're going to be talking about collaborating to curb medication costs with CivicaRX. And in just a moment, we're going to bring in our guest who is Dr. Daniel Roth. He serves as Executive Vice President and Chief Operating Officer for Trinity Health. He's also a board member of CivicaRX. And we're going to talk a lot about CivicaRX and the idea of this health utility model. And we'll get into that in just a moment. But Josh, this topic, again, we're talking about collaboration, United for Change, different ways our members in Catholic healthcare can work with others to really elevate human flourishing. So what was it about this topic to kind of set the context for our listeners that got your attention?
Josh Matejka (00:59):
Yeah. Thanks, Brian. And I certainly, I won't be able to provide as much detail into this model as Dr. Roth will. And I'm very glad he's joining us today. But CivicRx is a group that we've been covering at CHA for years. If you go back through our Catholic Health World archives, there are many articles over the years about their different initiatives, about when they started in 2018. And I think one of the most interesting things about it is that Catholic healthcare has taken a leadership role from the very beginning, but it isn't exclusively a Catholic health enterprise. It's joining together with all these other health entities to tackle one of the biggest issues facing patients in America, which is medication costs. It's so expensive to get medications. And I mean, in our national work, we've seen that. When we talk to people about their biggest concerns in healthcare, it's medicine is expensive and some people don't want to get it because even if they need it, because they're like, "I can't afford to pay the bills on this.
(02:00)
" So what CivicRX is doing is really important in tackling that very specific issue, but very important issue. And like I said, the way that Catholic Health has taken a leadership role, but a very collaborative role throughout the life of CivicRx is really encouraging and very cool. And I'm very excited for Dr. Roth to break that open for us today.
Brian Reardon (02:19):
Well, let's go ahead and bring in Dr. Roth. Again, he serves as executive vice president and COO for Trinity Health. He's also a board member of CivicaRX. Dr. Roth, thanks for joining us.
Dr. Daniel Roth (02:30):
Thanks for having me. And it's great to be with you. It's good to see you again, Brian, and good to be with you both.
Brian Reardon (02:34):
Yeah, good to see you. So I noticed you go to civicarex.org, the website. The first words you see are the nonprofit solution for reliable drug supply. I guess a good place to start is, why was Civica founded? How did it come into creation?
Dr. Daniel Roth (02:54):
It's a fantastic question. And it was a great beginning point. It really is a beginning point, but it really began with, we were at a time when we, in healthcare, particularly on the hospital side, we're constantly experiencing drug shortages. So there was one after another, either because of a disruption in the supply chain or just changes in production where our caregivers, our physicians and providers didn't have access to some of the key medications you would need on a regular basis to care for patients. And we actually had regular meetings to figure out how we were going to navigate shortages and be able to provide care for people. And it was just such a broken system and problem that coming together made all the sense in the world just to fix as a start that let's make sure that our patients and our pharmacists and caregivers and nurses and doctors had the drugs and medications they needed to care for patients every day.
(03:46)
And we thought by coming together, we could collectively solve that and we have.
Brian Reardon (03:52):
And this supply chain issue really precedes COVID. I know that got a lot of attention during COVID and after COVID, but CivicRX predates that by I think a number of years, correct?
Dr. Daniel Roth (04:04):
It does. It predated by a couple of years. And it turned out to be fortunate because during the pandemic, then some of those key medications that we needed at scale, things like steroids that we used early on in the treatment of COVID that might have been insured supply. Otherwise, Civica could be part of the solution in making sure we had access to those medications and antibiotics. And so yeah, the timing was fortuitous with regard to the pandemic and the ball was already rolling and we could be ready to meet that need.
Brian Reardon (04:35):
And Josh mentioned Catholic Healthcare came together with other healthcare providers. Can you tell us a little bit about who makes up sort of the board or the, I guess, governance body over CivicaRX?
Dr. Daniel Roth (04:46):
Yep. So the governance body is a combination of nonprofit health systems, as well as some for- profit health systems, but some of which are Catholic systems like us and Providence and SSM and some other faith-based systems, and also a number of philanthropies that were part of this from the beginning to help us who had the same mission in mind, who had the same service to community in mind, all willing to come together to solve this common problem. I think one of the terms that was used early on and coined by others was this notion of disruptive collaboration. And so we wanted to be disruptive collaborators. And so it was really a series of like- minded entities, some health systems, some philanthropic organizations coming together to do this. And then also leaders who came in to run Civica, who came out of the pharmaceutical industry, all coming together to serve on the board and to serve the mission of Civica and serve its members.
(05:41)
It really has been a fantastic experience.
Brian Reardon (05:43):
Yeah. And I think you started off really fairly limited in the number of drugs that ... And again, these drugs are being manufactured and the idea is not to create profit, but really to turn what was a for- profit sector of the healthcare industry and make it sort of collaborative capitalism in a way. So how did that sort of work from a practical standpoint to come together, again, healthcare providers that aren't pharmaceutical companies to work with those who have expertise in this field to actually manufacture the drugs you needed. And it's kind of a multi-part question, I guess, but how did you decide where to start in this process? Because it seems pretty overwhelming if you kind of got together one day and said, "Hey, we should manufacture our own drugs to use in our hospitals." Great idea, but I'm sure it was very process involved and a lot of work went into getting it set up.
Dr. Daniel Roth (06:39):
There's a ton of work involved in setting it up and a ton of forethought. And just as a reminder in the beginning, these even weren't the expensive drugs. Some of the reasons why these drugs were in short supply is because they were actually cheap. These were generic medications that were cheap, but then they weren't produced at scale because there wasn't the motivation on behalf of some of the manufacturers to produce them, which led to some of the reasons for short supply as well as quality issues and their manufacturing. And so that was the original part of it. Later in this, we came to the notion of there are drugs like insulin, which are very expensive, which our patients and communities need and would benefit by a more affordable route, but it actually started with cheap drugs that were in short supply. And really it came together with then the health systems coming together and deciding which medications would have the greatest value and then coming together to decide how we purchased those originally.
(07:34)
They were purchased through what we call private label distribution. So you're getting them manufactured elsewhere, but on behalf of Civica and then Civica distributes them as Civica has grown, the number of drugs have grown. There are now dozens of drugs that we get from Civica at Trinity Health to do that and it continues to grow, but it really is based on what the need is as the organization. The second part of your question I would add is that there really is ... I work at Trinity Health. We're a relatively big organization, but one of the things that you realize as you start to deal with some of the more challenging problems in healthcare is we're too small to fix that at Trinity. We have to be part of community. And so by coming together with a bunch of other organizations who come bring different backgrounds and people, people with a pharmaceutical background, people with a manufacturing background, faith-based systems, other nonprofit systems coming together to actually put our best thoughts forward really was how we began to solve what was, to your point, a very big and complicated problem, breaking it down to parts and collaborating and making the right investments.
Brian Reardon (08:38):
And is the participation in CivicaRX open to anybody? I mean, what does it take for a health system to say, "Hey, sign me up. I want to be part of this.
Dr. Daniel Roth (08:47):
" Yeah. So there are about 60 members today of hospitals and health systems that are participating and they are continuing to grow and Civica is still working. There are hundreds of hospitals across the country. I think there's about 1,400 hospitals across the country that receive medications from Civica, and that number continues to grow. There are more hospitals and health systems that are welcome to join and Civica is always talking to new members to continue to grow because the problem, although it is much better, doesn't go away. And having a stable supply of affordable medications is foundational. And so yeah, they continue to grow and Civica is still entertaining new membership with new hospitals and health systems.
Brian Reardon (09:25):
And how does the pharmaceutical industry look at CivicRX? Are they see you as a sort of value or a competitor or collaborative? What's the take on that? Is there bringing any pushback from the pharmaceutical industry?
Dr. Daniel Roth (09:37):
We haven't really gotten pushback. I think as we've driven some of the changes, there's been matching based upon what the market will drive. So by way of example, the cost of insulin, when Civic was able to come out with a vial of insulin at $30, now the price of insulin has dropped down to $30. And so I think it's been driving the marketplace in that way, but I don't see it really so much as competition. Maybe you could call it coopetition, but it really is just around trying to drive the marketplace to where we can and where patients and communities really need it, but it's not a direct competition. And at the end of the day, part of the reason why, by way of example, the shortage problem is better is because lots of other people came in to fill the shortage problem too. And at the end of the day, that was the most important thing.
(10:25)
We had a system that was broken, it's not broken anymore, and that was because Civica drove that, but others drove that as well, and that's where we welcome that.
Brian Reardon (10:33):
Yeah. And this concept of disruptive collaboration of working collaboratively for the common good, I got to believe, Dr. Roth, there's other ways that this could be applied to other sectors of the healthcare industry. And can you talk a little bit about where's the potential for this? And I know I had mentioned that we've got an article in the Spring Issue of Health Progress by Carter Dredge, very involved obviously with the creation of CivicaRX was talking about that now that this was primarily set up for hospitals to the medications that they use for inpatients, but now there's a version of this for consumers, right? So that's, I guess, one first example of how this model's been applied in different spaces.
Dr. Daniel Roth (11:18):
Yeah. So what you're referencing is a company called Civica Script, which is a sister company of CivicaRX, the original founding company that we've been talking about. CivicaScript is another good example within industry where there are many generic, but really important, but somewhat rare medications that are very expensive. And so Civica Script is a partnership between Civica and a number of Blue Cross Blue Shield health plans to make expensive drugs affordable on behalf of their members. And so that's another great example of disruptive collaboration, bringing together key stakeholders who have the same goals in mind and the same endpoints in mind, but solving a complicated problem. They've been able to solve that. There are drugs, the first drug they did was called abiraterone, which is for prostate cancer and really very expensive, $200 a month now, much cheaper because of that collaboration. And now there's a long list of medications through Civica Script that patients benefit from.
(12:15)
But really, to your point, I really hope, and I really believe this can be the first of many. Civica should be the first of many for disruptive collaboration. We all work in a system that has many challenges and we feel the pressures every day to make it more affordable, make it more accessible, and we have to do that, but it's a complicated system.
(12:37)
Nobody would've built a healthcare system like this if you're building it from scratch in 2026, just not the way it would have happened, but here we are and we have to all come together to solve it. And so I think this concept of disruptive collaboration will be a model for people with like minds to come together and solve some of those vexing problems. So I think there are many examples of areas where we can do this and come together because it's such a big problem. Even big health systems are too small to fix it by themselves. And so I think, I hope and anticipate this is a first of many, and there are a number of areas of our our health system within how we care for populations of patients, how we manage the cost of care, how do we solve the technology problems that we, and the opportunities we face?
(13:21)
There are many opportunities for like- minded systems to come to the table and solve these problems together. And we all bring special and unique gifts. We as Catholic systems bring special and unique gifts to that, which we can talk about, but we can't do it by ourselves. And we also can't just do it as health systems really requires a multidisciplinary approach. And so I really am passionate that I think Civica is great and Civic will be even better when there are 10 more civic-like organizations driving disruptive collaboration.
Brian Reardon (13:54):
And to look ahead in different areas, it seems to me the workforce, supply chain. What are some of the spaces that this model could be applied to to really, as we say in CHA as part of our strategic plan, we have a number of areas we're focusing on. Access to care obviously is a big one. And that relates to people able to afford healthcare and whether it be insurance or Medicaid. But the second pillar we have is around health reimagine, really taking a step back. And as you said, and I think we all agree that the system is not one we would've designed from scratch. And is this an opportunity to go to different spaces and apply this model to really change the way that healthcare is delivered?
Dr. Daniel Roth (14:39):
It is most definitely that opportunity. And the number of possibilities is really just the same number of challenges we face. So you touched on some of them. We face a workforce crisis. How do we continue to have a constant dream of people who are excited to be in healthcare and excited to be caregivers and to stay in there? And so how do we come together to do that? There are many opportunities for us to come together for training and developing workforce, right? Even starting with people when they're early in their careers or in school, right? That's one. Workforce is a big problem. Technology is another opportunity. We have a world coming to us in artificial intelligence coming together to solve that as another opportunity for like- minded systems to come together to do that. So the supply chain is a third good example that you referenced.
(15:22)
The fourth is around interoperability and how do we share information and sort of make it easier for patients to navigate a complicated system. I think that the number of problems equals the number of opportunities. We just have to put our mind to them and really prioritize which ones make the most sense.
Brian Reardon (15:39):
And as this disruption occurs, what are cautions? I mean, obviously anytime you disrupt something, there's going to be somebody who's been disrupted and may not be real happy about it. So is there any sort of caution of how you have to maybe tread carefully in taking this approach?
Dr. Daniel Roth (15:56):
Oh, for sure. For sure there are cautions. And you really have to think about the different stakeholders and how they'll respond and be agile enough and see around the corners enough to be able to respond to that. And we've learned right on the Civica journey for that, and we continue to learn in the Civica journey to do that. I think that there are a number of people who, like I mentioned earlier, who have come in to solve the same problem now. Civica was the disruptor. Civica was the instigator. Now other people come in and then that how evolves how Civica manifests its mission. So yeah, and as I mentioned, other stakeholders will also respond. So those people that are getting disrupted will respond to disruption. And being comfortable with that and being comfortable with sometimes just changing that the underlying problem is enough is the definition of success and Civica did that, but we do have to think more about how those that are being disrupted will respond and how we'll respond to that and thinking around the corner.
(16:57)
That's one of the things we're going to have to do better going forward.
Brian Reardon (17:00):
Yeah. Great model. Let me bring Josh back into the conversation. Josh, you've been listening to Dr. Roth and I describe CivicRx talk about the potential of this model. Anything that comes to your mind to either follow up or comments?
Josh Matejka (17:14):
Yeah. And I mean, Brian, you almost stole the question that I was forming in my head with that last one, but I am really curious about this concept of disruption. I think as someone who follows the news, disruption is often a word that I see in the tech industry that is used to say, "Oh, we're disrupting the norm." But a lot of times that disruption can end up trickling down to the consumer or in this case, the patient and it creates more barriers. And sometimes that's totally not planned at all. And you talk about needing to understand who the stakeholders are and put up different cautions so that you're not disrupting things for the person who ends up needing the medicine. It's more about disrupting bad practices and bad habits within the industry. But I guess at the board level and really in your role at Trinity, how do y'all try to make sure that that disruption doesn't carry down to the patient, that ultimately the experience for them is better than what they experienced before?
Dr. Daniel Roth (18:16):
I think the organizations in Civica did this certainly have to be constantly focused on their mission, right? And look, there's tensions there, right? There will be tensions there, there were tensions there at Civica, there will be tensions in these things, but you have to be really focused on the mission. One of the things that we bring from a Catholic healthcare perspective is the notion of serving the common good. And so we bring that voice to that, but we don't have the market cornered on that, right? It's Catholic health systems or at Trinity, the philanthropy organizations that participate in this, the other health systems all do. So I think one is as a vigorous, continued focus on what your primary mission is and always looking to serve that. I think we've done a good job of that civic. And I think that's why we are really well positioned to be key components of these disruptive collaborators going forward because we've been living this mission in Catholic healthcare for a century and a half.
(19:09)
And while things change, if you stay focused on your mission and your values, then you end up making the right decisions. And I think that's what you have to do so that disruption doesn't go the wrong way or hurt the people you're trying to help, but I think you just have to be laser focused on that. And that question is constantly asked of the civical board, where is this consistent with our mission? And I think it's no different that it's constantly asked at Trinity Health. When we go through and we make changes and we're trying to internally disrupt or make changes in our organization, we are constantly discerning and asking ourselves, how is this consistent with our mission and our values and our sponsors? And I think that bringing that to the table makes the difference and makes sure that what you're properly worried about, Josh, doesn't happen.
Brian Reardon (19:54):
Yeah. And the last thing I would say as we wrap the conversation up, as I mentioned the CHA strategic plan, again, the two pillars I mentioned were access to care, Care for All and Health Reimagined. The third one, which has been the theme of this season of podcast is United for Change. And Dr. Roth, if you could kind of maybe wrap up the conversation by really reflecting on how does this model, how does what CivicaRX is doing and some of the other opportunities that exist really speak to Catholic healthcare's goal to be united for change?
Dr. Daniel Roth (20:25):
Yep. As we've touched on a little bit, so far in the conversation is it really is, we are uniquely situated in Catholic healthcare to be leaders of disruptive innovation. It's such a confluence of time with the changes that we knew. There is a crisis in healthcare in our country and we do need to be drivers of that change. And I believe that we Catholic Healthcare Systems, Catholic Health Association are perfectly situated to be leading these types of things, right? We have the right mission, the service to the common good, we have the right background, but we can't do it by ourselves. But I think we've served in community for a long time using different definitions of that word and we will continue to serve in a healthcare community. But I think that the world that we're called to now has to be bigger than ourselves to solve the problems that we face.
(21:17)
But I think we are perfectly situated to be leaders and participants in that type of disruption. And I think it's completely consistent with that third pillar.
Brian Reardon (21:28):
Yeah. I agree and really appreciate your comments and the work you're doing. I know you've got a big job at Trinity and to also serve on the board of CivicaRX. Thank you for doing that and for your leadership.
Dr. Daniel Roth (21:41):
Thanks for having me. Thanks for focusing on this topic. It's a critically important topic and thanks for what you do every day.
Brian Reardon (21:46):
Definitely. Again, that was Dr. Daniel Roth. He serves as Executive Vice President and Chief Operating Officer for Trinity Health. He's also a board member of CivicaRX. Again, this has been another episode of Health Calls, the podcast of the Catholic Health Association of the United States. I'm your host, Brian Reardon. Josh Matejka is our executive producer. HealtCall's scheduling coordinator is Sarah Marchant, and the podcast is produced here in St. Louis at Once Films. You can find all episodes of podcasts, of course, at the CHA website, that's chausa.org. Just click at the top of the page under news and publications, and you can find all of our podcasts there. Of course, you can also get health calls on all of your favorite streaming platforms such as Spotify, Apple Podcasts. We're also on YouTube. And if you do get us through one of the streaming platforms and you like the conversations, please give us feedback through ratings.
(22:41)
We'd really love to hear back from you. And as always, thanks for listening.